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Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 35 - about premiums may also be found on the DSS website and in outreach/educational materials. The premium is based on family size and income to ensure that no family pays more than 5% of their income for coverage. The invoice that is due in July for August health care coverage reflects the new premium amount. The premium chart is updated and mailed to recipients annually each June. The Missouri General Assembly considered and approved a statutory change to allow for the submission of a combination SCHIP State Plan in Senate Bill 577 passed by the 94th Missouri General Assembly on May 18, 2007, and signed by the Governor on July 2, 2007. To ensure public input in Missouri's Separate Children's Health Insurance Program, the MO HealthNet Division conducts quarterly meetings with the following groups.  Managed Care Consumer Advisory Committee  All Plan Meeting  Quality Assessment and Improvement Advisory These meetings are scheduled one year in advance and are open to group members, MO HealthNet Division personnel, and invited guests. These meetings are also open to members of the public. Meeting notices are posted at the State Capitol, the Broadway State Office Building, Department of Social Services offices, the Howerton Building, the Jefferson Building, and on the MO HealthNet Division website at http://www.dss.mo.gov/mhd/. A presentation on the change from a Medicaid expansion to a combination SCHIP program was given at the June 20, 2007 Managed Care Consumer Advisory Committee meeting. A similar presentation will be given at the Quality Assessment and Improvement Advisory group meeting on July 25, 2007, and the All Plan Meeting on July 26, 2007. 8.4 The State assures that it has made the following findings with respect to the cost sharing in its plan: (Section 2103(e)) 8.4.1  Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e)(1)(B)) (42 CFR 457.530) 8.4.2  No cost-sharing applies to well-baby and well-child care, including age- appropriate immunizations. (Section 2103(e)(2)) (42 CFR 457.520) 8.4.3  No additional cost-sharing applies to the costs of emergency medical services delivered outside the network. (Section 2103(e)(1)(A)) (42 CFR 457.515(f))